Liposuction alone can effectively treat Grade I Webster/Simon gynecomastia cases. The procedure involves making small incisions, infiltrating a numbing solution, and using a thin cannula to suction excess fat. It is suitable for patients with good skin elasticity and minimal glandular enlargement. Additional techniques like glandular tissue excision or skin tightening may be needed for optimal results in cases of significant enlargement or excess skin. Advanced techniques like power-assisted liposuction (PAL) and ultrasound-assisted liposuction (UAL) have improved outcomes. UAL, including Vibration amplification of sound energy at resonance (VASER), is particularly effective for treating fibrous glandular tissue while ensuring skin contraction and minimizing risks.
Other Surgical Options
For cases with excessive glandular tissue, liposuction may not be sufficient, and a pull-through surgical technique can be used. This technique, originally described by Morselli, utilizes the same incisions used for liposuction to access and remove glandular tissue. Under anesthesia, blind dissection is performed to separate the tissue from the skin and pectoral fascia. The glandular tissue is then carefully pulled through the liposuction incisions for piecemeal excision. This technique minimizes additional scars and allows for direct removal of glandular tissue that cannot be effectively eliminated through liposuction alone.
The periareolar technique, also known as the Webster technique, is a commonly used procedure for gynecomastia surgery. It involves making an incision along the lower half or one-third of the border of the areola. This technique is suitable for various grades of gynecomastia. Under anesthesia, the surgeon carefully removes excess glandular tissue through the incision, strategically placed to minimize visible scarring. Liposuction may be performed simultaneously to contour surrounding fatty tissue. If there is minimal skin excess, the remaining skin is tightened for a more masculine appearance, and the areola can be resized or reshaped if needed.
Reflecting on these Methods
Gynecomastia surgeries, such as the pull-through technique and the periareolar technique, have their limitations and drawbacks, prompting the development of a new surgical method. The pull-through technique may result in incomplete glandular excision, lack precision and control, and carry a risk of tissue trauma or injury. On the other hand, the periareolar technique may leave visible circular scars and pose a risk of areolar distortion. In light of these limitations, a pioneering surgical approach has been introduced to address these issues. The pull-through technique minimizes scarring but can yield unpredictable outcomes, while the periareolar technique allows direct visualization but may leave permanent visible scars under each areola. The new method aims to overcome these drawbacks and provide improved results for gynecomastia patients.
